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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370875
Report Date: 03/22/2021
Date Signed: 03/22/2021 12:06:36 PM

Document Has Been Signed on 03/22/2021 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CALIFORNIA KIDS CENTERSFACILITY NUMBER:
304370875
ADMINISTRATOR:SIPIA, CATHYFACILITY TYPE:
850
ADDRESS:2428 N. GRAND AVENUE #HTELEPHONE:
(714) 832-2669
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
03/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Cathy Sipia, DirectorTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs ) Mila Quinto and Lou VanZant conducted a case management inspection to the above facility due to a deficiency discovered during a complaint investigation. LPAs met with Director, Cathy Sipia. Census was taken. A review of the Facility Personnel Report Summary on this date (3/22/21)indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. However, staff member Jennifer Martinez has a clearance and associated to the school age component but is not associated to the preschool component.

Through the course of the complaint investigation, though the staff member has clearance and associated to the school age component, the staff is not associated to the preschool component.

LPA requested for the current children’s roster; however, the Director does not have a current roster available.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 and Health and Safety Code were observed, discussed and cited at the time of the visit. The following violations were observed and cited today: Criminal Record Clearance 101170(f) and Current Roster of Children provided care in facility required 1596.841 (see LIC 809D).



An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/22/2021 12:06 PM - It Cannot Be Edited


Created By: Mila Quinto On 03/22/2021 at 11:18 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CALIFORNIA KIDS CENTERS
FACILITY NUMBER: 304370875

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2021
Section Cited
CCR
101170(f)

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101170(f) Criminal Record Clearance A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another...
This requirement is not met as evidenced by:
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This Director will sign up for Guardian and will associate the staff member to the preschool component.
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Based on record review,the Director failed to associate staff member, Jennifer Martinez to the preschool component. This poses a potential health and safety of children in care.
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Type B
03/24/2021
Section Cited
HSC1596.841

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1596.841Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility.
This requirement is not met as evidenced by:
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This Director will update the children's roster and email to LPA at mila.quinto@dss.ca.gov by March 24, 2021.
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Based on record review, the Director failed to maintain updated children's roster records. This poses a potential health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rina Lopez
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2021


LIC809 (FAS) - (06/04)
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